University of Alberta Pre-survey Visit March 16, 2017

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Presentation transcript:

University of Alberta Pre-survey Visit March 16, 2017 Program Directors University of Alberta Pre-survey Visit March 16, 2017

Objectives of the Meeting To review the: Accreditation Process Categories of Accreditation Standards of Accreditation Role of the: Program directors Department heads Residents Program administrators

Accreditation Is a process to: Based on standards Improve the quality of postgraduate medical education Provide a means of objective evaluation of residency programs for the purpose of Royal College accreditation Assist program directors in reviewing their own program Based on standards

Principles of the Accreditation Process Based on General and Specific Standards Based on CanMEDS Onsite regular surveys Peer-review Input from specialists Categories of Accreditation

Pre-Survey Process University Royal College Specialty Committee Questionnaires Specialty Committee Questionnaires Royal College Comments Questionnaires and Comments Comments Program Director Surveyor

Role of the Specialty Committee Prescribe requirements for specialty education Program standards Objectives of training Specialty training requirements Examination processes FITER Evaluates program resources, structure and content for each accreditation review Recommends a category of accreditation to the Accreditation Committee

Composition of a Specialty Committee Voting Members (chair + 5) Canada-wide representation Non-voting Members Chairs of exam committee National Specialty Society (NSS) ALL program directors

The Onsite Survey Team Chair – Dr. Glen Bandiera Deputy Chair – Dr. Alan Chaput Surveyors will be a specialist from another discipline one surveyor per program Resident representatives (RDoC) one to four representatives (depends on the number of programs) accompany surveyors on selected program reviews Regulatory authorities representative (FMRAC) Teaching hospital representative (HealthCareCAN) Other observers DENIS

Resident Survey As part of the accreditation process the resident associations send an anonymous, confidential survey to all residents in all programs four to six months prior to the onsite survey Results collated, reports are written by the provincial organization president or designate which are sent to RDoC/FMRQ president to review Final Royal College accreditation report given ONLY to resident representatives on the survey team

Role of the Surveyor Evaluate how the program is meeting standards at the time of survey Looking for ‘evidence’

Information Given to Surveyors Questionnaires and appendices Completed by program Program-specific standards (OTR/STR/SSA) Report of last regular survey Plus report of mandated Royal College review since last regular survey, if applicable Specialty Committee comments Also sent to PGD / PD prior to visit Exam results for last six years

The Survey Schedule Includes: Document review (45 min) Meetings with: Program director (75 min) Department head (30 min) Residents - per groups of 20 (60 min) Teaching faculty (60 min) Residency Program Committee (60 min) DENIS There is some flexibility – the meetings highlighted in grey can be moved around but other meetings needs to follow given sequence

The Survey Schedule Document review (45 min) Residency Program Committee minutes Resident assessment files Picked at random from each year Resident in trouble/remediation

Residency Program Committee – Minutes (B1) Does Committee fulfill all of its responsibilities? Provides information on issues discussed and follow-up action taken by RPC Appropriate representation on Committee Site coordinator(s) Resident(s) - elected Meets regularly, at least quarterly

Resident Assessments (B6) Looking at the process of how residents are assessed e.g. timely, face-to-face meetings * Confidentiality form signed by the surveyor.

Meeting with Program Director (75 minutes) Description of program Review of strengths and weaknesses Response to previous weaknesses Last Royal College review Resources and support for program director Clarification of questionnaire Review of Specialty Committee comments Sent by email prior to visit Review of standards

Meeting with Department Head (30 minutes) Overview of strengths and weaknesses Time and support for program director Faculty assessments Resources To support residency program Research environment Overall, priority of residency program

Meeting with ALL Residents (1 hour / 20 residents) Group(s) of 20 residents Looking for balance of strengths and weaknesses Focus is on standards Evaluate the learning environment

Topics to discuss with residents Objectives Educational experiences Service /education balance Increasing professional responsibility Academic program / protected time Supervision Assessments of resident performance Evaluation of program / assessment of faculty Career counseling Educational environment Safety

Meeting with Teaching Faculty (1 hour) Involvement with program Goals and objectives Resources Assessments of residents of faculty performance Is teaching valued?

Meeting with Residency Program Committee (1 hour) Program director attends first half of meeting All members of RPC attend, including resident members Review of responsibilities of committee Opportunity for surveyor to provide feedback on information obtained during previous meetings

The Recommendation Survey team discussion Feedback to program director Typically evening following review Feedback to program director Exit meeting with surveyor Typically the morning after review Survey team recommendation Category of accreditation Strengths and weaknesses

Categories of Accreditation Approved by the Royal College, CFPC and CMQ Accredited program Follow-up: Next regular survey Progress report (* a category determined only by the Accreditation Committee) Internal review External review Accredited program on notice of intent to withdraw accreditation

Categories of Accreditation Definitions Accredited program with follow-up at next regular survey Program demonstrates acceptable compliance with standards

Categories of Accreditation Definitions Accredited program with follow-up by College- mandated internal review Major issues identified in more than one standard Internal review of program required and conducted by University Internal review report due within 24 months

Categories of Accreditation Definitions Accredited program with follow-up by external review Major issues identified in more than one standard AND concerns - are specialty-specific and best evaluated by a reviewer from the discipline, OR have been persistent, OR are strongly influenced by non-educational issues and can best be evaluated by a reviewer from outside the University External review conducted by two to three people within 24 months Same format as regular survey

Categories of Accreditation Definitions Accredited program on notice of intent to withdraw accreditation Major and/or continuing non-compliance with one or more standards which calls into question the educational environment and/or integrity of the program External review conducted by three people (two specialists + one resident) within 24 months At the time of the review, the program will be required to show why accreditation should not be withdrawn

RESIDENCY accreditation committee After the Survey survey team Reports specialty committee royal college university Report and Response Reports Responses Recommendation Reports and Responses RESIDENCY accreditation committee

Residency Accreditation Committee Voting members (24): Chair and Vice Chair of the Residency AC Chair of the International residency Program Review (1) Association of Faculties of Medicine of Canada (2) Collège des médecins du Québec (1) Resident Associations (2) Regulatory Authorities (1) Fellows (17 including Chair and Vice Chair) Non-voting / observers (10): HealthCareCAN Accreditation Council for Graduate Medical Education Association of Faculties of Medicine of Canada Canadian Resident Matching Service College of Family Physicians of Canada Collège des médecins du Québec Committee on the Accreditation of Canadian Medical Schools Resident Associations

Information Available to the Residency Accreditation Committee All pre-survey documentation available to the surveyor Survey report Program response Specialty Committee recommendation History of the program

Residency Accreditation Committee Decisions Residency Accreditation Committee meeting June 2018 Dean and postgraduate dean attend Sent to University Specialty Committee Appeal process is available (within 60 days)

Preparing for the Survey Role of the Program Director Pre-Survey Complete questionnaires Inform teaching faculty Meet with residents Organize documents (in collaboration with P.A.) Develop schedule (in collaboration with P.A.) Tours of wards/clinics not necessary Coordinate transportation arrangements (in collaboration with P.A.)

Preparing for the Survey Role of the Program Director During Survey Logistics (in collaboration with P.A.) Schedule Remind participants Ensure ALL residents meet with surveyor Off-site residents by tele/video-conferencing Transportation Exit meeting with surveyor Time and location to be confirmed

Questions?

General Standards of Accreditation “A” Standards Apply to University, specifically the PGME office “B” Standards Apply to EACH residency program “C” Standards Apply to Areas of Focused (AFC) diploma programs

“B” Standards B1 Administrative Structure B2 Goals and Objectives B3 Structure and Organization of Program B4 Resources B5 Clinical, Academic and Scholarly Content of Program B6 Assessment of Resident Performance DENIS

B1 – Administrative Structure B1.1 Program Director Overall responsibility for program Acceptable qualifications Royal College certification *NEW* Sufficient time and support Generally interpreted as non-clinical time for program administration Impact to operation of program

B1 – Administrative Structure B1.2 Residency Program Committee (RPC) Representative from each site and major component Resident member of Committee One elected by the residents Accountability Meets regularly, four times/year; keeps minutes Communicates regularly with members of program, department, residents Members responsible for bilateral flow of communication with the specific constituencies they represent

B1 – Administrative Structure B1.3 Responsibilities of RPC Planning and operation of program Selection of residents Assessment and promotion of residents Appeal mechanism Career planning and counseling Manage stress

B1 – Administrative Structure B1.3 Responsibilities of RPC Ongoing review of program Clinical and academic components Resources and facilities Teachers Feedback mechanisms Learning environment Anonymous Resident safety Written policy

B1 – Administrative Structure B1.4 Site Coordinator B1.5 Research coordinator B1.6 Environment of inquiry and scholarship

B1 – Administrative Structure “Pitfalls” Residency Program Committee dysfunctional Unclear Terms of Reference (membership, tasks and responsibilities) Agenda and minutes poorly structured Poor attendance Department head unduly influential RPC is conducted as part of a Dept/Div meeting No resident voice

B2 – Goals and Objectives B2.1 Overall statement B2.2 Structured to reflect the CanMEDS competency Used in planning and assessment of residents B2.3 Rotation-specific Used in planning and assessment of residents B2.4 Resident and staff have copies Used in teaching, learning, assessment Learning strategies developed at start of rotation B2.5 Regular review At least every two years

B2 – Goals and Objectives “Pitfalls” Missing CanMEDS Roles in overall structure Okay to have rotations in which all CanMEDS Roles may not apply (research, certain electives) Goals and objectives not used by faculty/residents Goals and objectives dysfunctional – does not inform assessment Goals and objectives not reviewed regularly

B3 – Structure and Organization B3.1 Program provides all components of training as outlined in the specialty-specific documents Objectives of training (OTR) Specialty training requirements (STR) Specific standards of accreditation (SSA) B3.2 Appropriate supervision According to level of training, ability/competence and experience B3.3 Increasing professional responsibility B3.4 Senior resident role B3.5 Balance of service and education Ability to follow academic sessions

B3 – Structure and Organization B3.6 Equivalent opportunity for each resident B3.7 Opportunity for electives B3.8 Role of each site clearly defined B3.9 Safe learning/educational environment Free from intimidation, harassment or abuse Promotes resident safety B3.10 Collaboration with other programs whose residents need to develop expertise in the specialty

B3 – Structure and Organization “Pitfalls” Graded responsibility absent Service/education imbalance Service provision by residents should have a defined educational component including evaluation Educational environment poor

B4 – Resources B4.1 Sufficient teaching staff From appropriate health professions B4.2 Appropriate number and variety of patients, specimens and procedures Refer to specialty-specific documents B4.3 Clinical services organized to achieve educational objectives Training in collaboration with other disciplines Inpatient, emergency, ambulatory, community Age, gender, culture, ethnicity

B4 - Resources B4.4 Adequate educational resources Access to computers, on-line references Close proximity to patient care areas B4.5 Access to physical and technical resources in the setting where they are working Direct observation/privacy for confidential discussions Adequate space for residents B4.6 Adequate supporting facilities ICU, diagnostic, laboratory

B4 – Resources “Pitfalls” Insufficient faculty for teaching/supervision Insufficient clinical/technical resources Infrastructure inadequate

B5 – Clinical, Academic and Scholarly Content of Program B5.1 to B5.7 Academic program Organized curriculum Organized teaching in basic and clinical sciences "Evidence" of teaching each of the CanMEDS Roles

B5 – Clinical, Academic and Scholarly Content of Program “Pitfalls” Organized academic curriculum lacking or entirely resident driven Poor attendance by residents and faculty Teaching of essential CanMEDS Roles missing Role modeling is the only teaching modality

B6 – Assessment of Resident Performance B6.1 Based on Goals and Objectives Identified methods of assessment Level of performance expected B6.2 Assessment consistent with characteristic being assessed Based on specialty-specific requirements B6.3 Timely, regular, documented feedback Face-to-face meetings B6.4 Residents informed of serious concerns

B6 – Assessment of Resident Performance “Pitfalls” Mechanism to monitor, promote, remediate residents lacking Formative feedback not provided and/or documented Assessments not timely, not face to face Summative assessment (ITER) inconsistent with formative feedback, unclearly documents concerns/ challenges

Conjoint Residency Education Accreditation System Reform

The Canadian Residency Accreditation Consortium (CanRAC) Collaborative initiative between the Royal College, CFPC, and CMQ New system of residency accreditation: 21st century best practices in accreditation; Digitized; and, Aligned with the shift towards competency-based medical education (CBME). 57 11/13/2018

58

Shadow Surveyors Objective Role To leverage the knowledge and expertise of experienced surveyors acting as “shadow surveyors” at an onsite survey and collect the necessary feedback on the new standards and process in accordance to the accreditation reform objectives Role Evaluate and validate new standards and process during an onsite survey visit An “overlay” to the visit for selected programs or the institution to test the process with no impact to accreditation status / recommendations or decisions 59

Shadow Surveyor Code of Conduct The shadow surveyor: will act strictly as an observer during the onsite visit will not engage in the discussions at various meetings, will not ask questions or seek clarification will not influence in any way the recommendation of the surveyor and the survey team during the evening discussions will not have voting privileges on the program‘s accreditation status recommendation 60

University of Alberta Onsite Survey November 26 to December 1, 2017